The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids
The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids
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DOI：
10.1097/prs.0b013e3181c82dd5
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发表时间：
2010-02-01
影响因子：
3.6
通讯作者：
Ogawa, Rei
中科院分区：
文献类型：
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作者：
Ogawa, Rei
背景：以前关于增生性瘢痕和瘢痕疙瘩治疗的报道没有描述多模式治疗的明确算法。本文提出了一个基于证据的审查以前的文章，并提出了算法的治疗和预防增生性瘢痕和瘢痕疙瘩。方法：临床试验的方法学质量进行了评估，并提取了患者的基线特征和干预措施，并应用其结果。促进增生性瘢痕/瘢痕疙瘩发展的重要因素包括伤口上的机械力、伤口感染和异物反应。对于瘢痕疙瘩，应采用的治疗方法取决于是否存在瘢痕挛缩（特别是关节挛缩），以及瘢痕疙瘩是小而单一，还是大而多。小的和单一的瘢痕疙瘩可以通过手术结合辅助治疗（包括放疗或皮质类固醇注射）或非手术单药治疗（包括皮质类固醇注射、冷冻疗法、激光和抗肿瘤/免疫抑制剂，如5-氟尿嘧啶）进行根治性治疗。大的和多发性瘢痕疙瘩难以从根本上治疗，目前只能通过旨在缓解症状的多模式疗法治疗。经过一系列治疗后，建议进行长期随访。保守疗法，其中包括凝胶片，录音固定，压缩治疗，外部和内部代理商，化妆（伪装）therapy.Conclusions的基础上，应管理的case-by-case：在过去的十年中，随机对照试验的数量增加，大大提高了疤痕管理，虽然这些研究受到各种限制。目前可用的增生性瘢痕/瘢痕疙瘩治疗算法很可能通过未来的高质量临床试验得到显著改善。（Plast。重建125：557，2010）。
Background: Previous reports on the treatment of hypertrophic scars and keloids have not described clear algorithms for multimodal therapies. This article presents an evidence-based review of previous articles and proposes algorithms for the treatment and prevention of hypertrophic scars and keloids.Methods: The methodologic quality of the clinical trials was evaluated, and the baseline characteristics of the patients and the interventions that were applied and their outcomes were extracted.Results: Important factors that promote hypertrophic scar/keloid development include mechanical forces on the wound, wound infection, and foreign body reactions. For keloids, the treatment method that should be used depends on whether scar contractures (especially joint contractures) are present and whether the keloids are small and single, or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (which includes radiation or corticosteroid injections) or by nonsurgical monotherapy (which includes corticosteroid injections, cryotherapy, laser, and antitumor/immunosuppressive agents such as 5-fluorouracil). Large and multiple keloids are difficult to treat radically and are currently only treatable by multimodal therapies that aim to relieve symptoms. After a sequence of treatments, long-term follow-up is recommended. Conservative therapies, which include gel sheeting, taping fixation, compression therapy, external and internal agents, and makeup (camouflage) therapy, should be administered on a case-by-case basis.Conclusions: The increase in the number of randomized controlled trials over the past decade has greatly improved scar management, although these studies suffer from various limitations. The hypertrophic scar/keloid treatment algorithms that are currently available are likely to be significantly improved by future high-quality clinical trials. (Plast. Reconstr. Surg. 125: 557, 2010.)